wrt compartment syndrome:
Unfortunately sometimes we have a continuum of physiological deformation / change, and at some arbitrary or defined point come up with a diagnosis. It is possible in my opinion, and is the way sports medicine is practiced her in Australia at least, to give a diagnosis that someone is progressing along the continuum, to the point where by investigative definition (ie. check their pressures) they may have or soon have a compartment syndrome if they continue to exercise at current levels. What then do you call their condition????
---
Scott Epsley
BPhty., MAPA, SPG.
PRINCIPAL PHYSIOTHERAPIST
Clifford Chambers Sports Medicine
Suite 4, 120 Russell Street
Toowoomba QLD 4350
Australia
e-mail: [log in to unmask]
On Wed, 10 Oct 2001 18:59:18
Jason Steffe wrote:
>
>List,
>
>I did some digging and came across research done by Stauber et al, showing some edema associated with DOMS after eccentric activity. I don't know what the parameters were (speed of elongation, load and rep's) as I don't have the study in front of me. But, the condition is self-limiting after 3 days of the initial bout of eccentric exercise. After that, there is DOMS immunity for 6 weeks (after as little as 1 bout of eccentric exercise). It wasn't clear to me how much edema was measured. In Mark Albert's book (Eccentrics in Sports and Ortho), he lists research showing that the most effective treatment for DOMS is .....exercise. He also postulates on whether it is even significant enough to try to focus treatment on the initial DOMS other than with the continued performance of the exercise program.
>
>I think that words are getting minced when we are talking of compartment syndrome...to me that is a diagnosis that requires surgical intervention (fasiciotomy) and can be diagnosed with various diagnostic studies. Am I off base with that line of thought? Anyone in the list care to help out? I'm admittedly not that familiar with the condition.
>
>Respectfully,
>
>Jason
>
> ----- Original Message -----
> From: Alison Dakin
> To: [log in to unmask]
> Sent: Wednesday, October 10, 2001 2:15 PM
> Subject: Re: Chronic Shin Splints
>
>
> Our sports med team use eccentrics to good effect on some patients with pain
> in their lower leg - whatever you care to call it. Our compartment syndromes
> however are usually decompressed following positive pressure studies and
> full biomechanical check for any other soft tisuue reason for their pain. I
> can't quote their success rate as I'm not running that part of the physio
> service anymore - but they do monitor their results carefully.
>
> Alison Dakin
>
> -----Original Message-----
> From: - for physiotherapists in education and practice
> [mailto:[log in to unmask]]On Behalf Of Scott Epsley
> Sent: 10 October 2001 12:48
> To: [log in to unmask]
> Subject: Re: Chronic Shin Splints
>
>
> Jason,
> I am aware of all of the uses and benefits of eccentric exercise you quote,
> and am quite impressed by your reference list. This however does not
> address the fact that eccentrics will make a compartment syndrome worse.
> ---
> Scott Epsley
> BPhty., MAPA, SPG.
> PRINCIPAL PHYSIOTHERAPIST
> Clifford Chambers Sports Medicine
> Suite 4, 120 Russell Street
> Toowoomba QLD 4350
> Australia
>
> e-mail: [log in to unmask]
>
>
> On Tue, 9 Oct 2001 19:04:33
> Jason Steffe wrote:
> >Scott,
> >
> >Barring biomechanical influences (which we don't know if there are any), it
> is my opinion that probable etiology of this patient's condition is not
> repeated eccentric loading, but rather insufficient eccentric strength given
> the functional demands (a weak eccentric/concentric muscle ratio which is
> termed critical deficit %).
> >
> >Eccentrics can be used therapeutically to strengthen the series elastic
> component, when speed and loads are controlled and progressed. Eccentrics
> are popular modes of exercise for treatment of overuse syndromes and
> tendinitis. Eccentric exercise does produce DOMS (theoretically because
> they selectively recruit Type II fibers and small motor units) but after
> minimal bouts of exercise one gains DOMS immunity for about 6 weeks. The
> rationale for eccentrics is to replicate and concomitantly condition the
> tissue for the high tensile stresses it must undergo during functional
> activities. It can be implemented in the subacute phase, again when
> controlled for speed and load.
> >
> >Please refer to:
> >
> >Jensen K, Di Fabio RP: Evaluation of eccentric exercise in treatment of
> patellar tendonitis. Phys Ther 69(3): 211-216, 1989
> >
> >Mannheimer JS: A comparison of strength gain between concentric and
> eccentric contraction. Phys Ther 49(11): 1201-1207, 1972
> >
> >Trudelle-Jackson E, Meske N, Highgenboten C, Jackson A:
> Eccentric/concentric torque deficits in the quadriceps muscle. JOSPT
> 11(4):142-145,1989.
> >
> >Albert MS, ed. Eccentric Muscle Training in Sports and Orthopedics, 2nd
> ed,. New York: Churchill Livingstone Inc,. 1995.
> >
> >I didn't make evaluative suggestions to the sender (I forget who asked the
> original question) because she/he didn't ask for them. The sender was asking
> for suggestions to give to a friend for home exercises for a chronic
> condition in a runner, not acute condition.
> >
> >Regards.
> >--------------------------------------------
> >Jason Steffe, PT, MS, MTC
> >Physiotherapy Associates
> >1901 Phoenix Blvd, Suite 205
> >College Park, GA. 30349
> >Ph: 770-907-1023
> >Fax:770-907-5608
> > ----- Original Message -----
> > From: Scott Epsley
> > To: [log in to unmask]
> > Sent: Monday, October 08, 2001 7:18 AM
> > Subject: Re: Chronic Shin Splints
> >
> >
> > Dear list,
> > I am about to be very critical - please do not take this personally, it
> is not aimed at individuals, but as a general comment.
> >
> > I cannot believe some of the replies about this problem. I know there
> are some very highly qulaified and intelligent people on this list - but the
> over simplification of the responses to this question is dreadful.
> >
> > Firstly, there is no such thing as "shin splints" generically. There
> must be a diagnosis, and if you must use this blanket term, it must be
> qualified by anterior or posterior. If one uses certain treatment
> suggestions for posterior shin splints on anterior shin splints, one can
> significantly worsen the situation, to the point of requiring surgery. And
> yes, I have seen it, and this poor lady can no longer walk without pain, and
> has permanent weakness.
> >
> > One needs also to establish if there is a component of compartment
> syndrome developing. Compartment syndrome is not shin splints, but often
> ensues. Usually it occurs in the anterior compatment (Tib Ant, EHL, EDL,
> Peroneus Tertius), or deep posterior compartment (Tib Post, FHL, FDL). One
> suggestion of eccentrically training the dorsiflexors has the potential to
> seriously worsen an anterior compartment syndrome, because that is the
> problem in the first place - over use of the dorsiflexors eccentrically. It
> has been shown that increased muscular swelling occurs with eccentric
> exercise. By the way, I wouldn't be strapping this too tightly, and
> certainly not circumferentially, even with elasticised bandage. The
> compartment needs all the help it can get at this point.
> >
> > Most likely there is a periostitis. This is "shin splints" if you must
> use this term loosely. However, one needs to determine that the periostitis
> is not in fact a stress fracture. Bone scan may help. A stress fracture is
> demonstrated by a very focal "hot spot", as opposed to a more diffuse lesion
> in periostitis.
> >
> > Then one must ascertain the cause, which is almost always biomechanical
> and occasionally overuse and biomechanical.
> >
> > Now and only now is it possible to treat this injury. There is no
> general treatment because it is not a general injury. Rest is effective -
> it is the easiest treatment suggestion of all - if it hurts don't do it.
> That doesn't fit my job description I'm afraid, I help people get back to
> doing things. Rest won't fix it either, it will only come back.
> >
> > If anyone wishes to know more about suggested treatment for specific
> conditions I would be happy to help. But please think a little more closely
> before applying a general treatment to a blanket term.
> >
> > Regards,
> > Scott.
> > ---
> > Scott Epsley
> > BPhty., MAPA, SPG.
> > PRINCIPAL PHYSIOTHERAPIST
> > Clifford Chambers Sports Medicine
> > Suite 4, 120 Russell Street
> > Toowoomba QLD 4350
> > Australia
> >
> > e-mail: [log in to unmask]
> >
> >
> > On Mon, 8 Oct 2001 09:56:50
> > Craig Lawson wrote:
> > >Here's a great, recently published article on Exercise induced leg pain.
> I
> > >will cut and paste it if people would like but it is quite long...
> > >
> > >http://www.physsportsmed.com/issues/2001/06_01/amendola.htm
> > >
> > >Craig
> > >
> > >-----Original Message-----
> > >From: [log in to unmask] [mailto:[log in to unmask]]
> > >Sent: Friday, 5 October 2001 02:18
> > >To: [log in to unmask]
> > >Subject: Chronic Shin Splints
> > >
> > >
> > >Hello-
> > >I am trying to help a colleague of mine out with chronic shin splints
> that
> > >he got in boot camp with the Marine Corps. Walking 10 minutes in
> sneakers
> > >bothers him and he has pain everyday.
> > >Running is out of the question at this point.
> > > I was looking for some "home" treatment ideas since this person is not
> > >currently attending P.T. in a clinic.
> > >Any ideas and help would be greatly appreciated.
> > >Thank you-
> > >Jean Momorella, MPT
> > >
> >
> >
> > Make a difference, help support the relief efforts in the U.S.
> > http://clubs.lycos.com/live/events/september11.asp
> >
> >
>
>
> Make a difference, help support the relief efforts in the U.S.
> http://clubs.lycos.com/live/events/september11.asp
>
>
Make a difference, help support the relief efforts in the U.S.
http://clubs.lycos.com/live/events/september11.asp
|